下颌前移装置治疗对合并阻塞性睡眠呼吸暂停低通气综合征的颈动脉粥样硬化患者脑血管反应性的影响
Impact of mandibular advancement device therapy on cerebrovascular reactivity in patients with carotid atherosclerosis combined with OSAHS.
作者信息
Qin Lu, Li Na, Tong Junyao, Hao Zeliang, Wang Lili, Zhao Ying
机构信息
Department of Dentistry, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China.
Department of Vascular Ultrasound, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China.
出版信息
Sleep Breath. 2021 Sep;25(3):1543-1552. doi: 10.1007/s11325-020-02230-x. Epub 2021 Jan 7.
PURPOSE
Obstructive sleep apnea-hypopnea syndrome (OSAHS) may affect cerebrovascular reactivity (CVR), representing cerebrovascular endothelial function, through complex cerebral functional changes. This study aimed to evaluate the change of CVR after 1-month and 6-month mandibular advancement device (MAD) treatment of patients with carotid atherosclerosis (CAS) combined with OSAHS.
METHODS
Patients with carotid atherosclerosis combined with OSAHS who voluntarily accepted Silensor-IL MAD therapy were prospectively enrolled. All patients underwent polysomnographic (PSG) examinations and CVR evaluation by breath-holding test using transcranial Doppler ultrasound at baseline (T0), 1 month (T1), and 6 months (T2) of MAD treatment.
RESULTS
Of 46 patients (mean age 54.4 ± 12.4 years, mean body mass index [BMI] 27.5 ± 4.5 kg/m), 41 patients (responsive group) responded to the 1-month and 6-month treatment of MAD, an effective treatment rate of 89%. The remaining 5 patients (non-responsive group) were younger (47.4 ± 13.5 years) and had a higher BMI (35.8 ± 1.8 kg/m). The responsive group had an improvement of apnea-hypopnea index (AHI) (events/h) from 33.0 ± 25.0 (T0) to 12.4 ± 10.4 (T1) and 8.7 ± 8.8 (T2), P < 0.001; minimum arterial oxygen saturation (minSpO) (%) increased from 79.8 ± 9.1 (T0) to 81.8 ± 9.4 (T1) and 85.2 ± 5.4 (T2), P < 0.01; longest apnea (LA) (s) decreased from 46.5 ± 23.1 (T0) to 33.3 ± 22.7 (T1) and 29.4 ± 18.5 (T2), P < 0.001; T90 (%) decreased from 10.3 ± 14.9 (T0) to 6.1 ± 11.8 (T1) and 3.3 ± 7.5 (T2), P < 0.05. Sleep architecture of these patients also improved significantly. The responsive group had a significant increase in left, right, and mean breath-holding index (BHI): left BHI(/s) from 0.52 ± 0.42 (T0) to 0.94 ± 0.56 (T1) and 1.04 ± 0.64 (T2), P < 0.01; right BHI(/s) from 0.60 ± 0.38 (T0) to 1.01 ± 0.58 (T1) and 1.11 ± 0.60 (T2), P < 0.01; mean BHI(/s) from 0.56 ± 0.38 (T0) to 0.97 ± 0.55 (T1) and 1.07 ± 0.59 (T2), P < 0.01), suggesting improved CVR.
CONCLUSION
Effective MAD therapy is beneficial for restoring cerebrovascular endothelial function in patients with CAS and OSAHS in a short period (1 month and 6 months).
TRIAL REGISTRATION
Clinical trial registration number: NCT03665818. September 11, 2018.
目的
阻塞性睡眠呼吸暂停低通气综合征（OSAHS）可能通过复杂的脑功能变化影响代表脑血管内皮功能的脑血管反应性（CVR）。本研究旨在评估经下颌前移装置（MAD）治疗1个月和6个月后，颈动脉粥样硬化（CAS）合并OSAHS患者的CVR变化。
方法
前瞻性纳入自愿接受Silensor-IL MAD治疗的颈动脉粥样硬化合并OSAHS患者。所有患者在MAD治疗基线（T0）、1个月（T1）和6个月（T2）时均接受多导睡眠图（PSG）检查，并通过经颅多普勒超声屏气试验评估CVR。
结果
46例患者（平均年龄54.4±12.4岁，平均体重指数[BMI]27.5±4.5kg/m²）中，41例患者（反应组）对MAD治疗1个月和6个月有反应，有效治疗率为89%。其余5例患者（无反应组）年龄较小（47.4±13.5岁），BMI较高（35.8±1.8kg/m²）。反应组的呼吸暂停低通气指数（AHI）（次/小时）从33.0±25.0（T0）改善至12.4±10.4（T1）和8.7±8.8（T2），P<0.001；最低动脉血氧饱和度（minSpO₂）（%）从79.8±9.1（T0）升至81.8±9.4（T1）和85.2±5.4（T2），P<0.01；最长呼吸暂停（LA）（秒）从46.5±23.1（T0）降至33.3±22.7（T1）和29.4±18.5（T2），P<0.001；T90（%）从10.3±14.9（T0）降至6.1±11.8（T1）和3.3±7.5（T2），P<0.05。这些患者的睡眠结构也有显著改善。反应组的左、右和平均屏气指数（BHI）显著增加：左BHI（次/秒）从0.52±0.42（T0）升至0.94±0.56（T1）和1.04±0.64（T2），P<0.01；右BHI（次/秒）从0.60±0.38（T0）升至1.01±0.58（T1）和1.11±0.60（T2），P<0.01；平均BHI（次/秒）从0.56±0.38（T0）升至0.97±0.55（T1）和1.07±0.59（T2），P<0.01），提示CVR改善。
结论
有效的MAD治疗有利于在短时间内（1个月和6个月）恢复CAS合并OSAHS患者的脑血管内皮功能。
试验注册
临床试验注册号：NCT03665818。2018年9月11日。
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